Interview with Marianna V. Spanaki, MD, PhD

Although it has been reported that the incidence of epilepsy increases after the age of 60, treatment of this population with antiepileptic drugs (AEDs) has been a challenge. Problems range from effectiveness and medication side effects to overall health status and the presence of other medical problems. Marianna Spanaki, MD, Neurology, Henry Ford Hospital in Detroit, and her colleagues studied AED use with regard to the elderly. They reported their findings at the recent annual meeting of the American Epilepsy Society. Dr. Spanaki told us that: "We decided to monitor practice trends between community physicians and specialists to determine whether the increased availability of new AEDs has influenced our prescribing habits in elderly epilepsy patients."

Methods and results

New referrals to epilepsy clinics at Henry Ford Hospital in Detroit were identified using an electronic database. According to the meeting report the investigators "collected data on the specialty of referring physician, age at epilepsy onset, etiology, AED upon initial evaluation, seizure control and calcium supplementation."

The researchers found that of 349 patients, 49 were older than 60 years of age. Within this group 23 were referred by primarily care physicians, 25 by community neurologists and 2 by neurosurgeons. It was determined that 69.4% were taking either one old AED or a combination of old AEDs. And just 11 patients on old AEDs were seizure free. Dr. Spanaki said that 95% of primary care physicians were still prescribing older AEDs, as were three out of four neurologists and neurosurgeons.


Dr. Spanaki noted that: "Ten years after the approval of new AEDs, their use is still very limited in the elderly for reasons that need to be further addressed. We see a need here for education, advocacy, and a follow-though on guidelines for prescribing."

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This article and interview with Dr. Spanaki was based on the paper, Antiepileptic Drug Use in the Elderly, by: ¹' ²Marianna V. Spanaki, ¹' ²Panayiotis N. Varelas, ¹Madhuri L. Koganti, and Brien J. Smith at the following institution(s) ¹Neurology Henry Ford Hospital, K-11, Detroit, MI; and ²Neurology, Wayne State University, Detroit, MI

Authored By: 
Rita Watson MPH
Marianna V. Spanaki MD PhD
Authored Date: